PROJECT ABSTRACT (CORE ACTIVITIES, CATEGORY B, EXISTING STATES) Pregnancy Risk Assessment and Monitoring System (PRAMS) was initiated in 1987 as part of the Centers for Disease Control and Prevention (CDC) initiative to reduce infant mortality and low birth weight. In recent years, the program has been expanded in support of CDC's Safe Motherhood Initiative to promote healthy pregnancies and the delivery of healthy infants. PRAMS is an ongoing, population-based surveillance system designed to identify and monitor selected maternal experiences and behaviors that occur before and during pregnancy and during the child's early infancy among a stratified sample of women delivering a live birth. As in the rest of the nation, Missouri (MO) has made little progress in reducing infant mortality rates during the past decade, with significant racial disparities. In an effort to improve the health of mothers and infants by reducing adverse pregnancy outcomes such as infant mortality, low birth weight, and preterm births, Missouri became a CDC PRAMS state, along with nine other new sites, in 2006 and began data collection in May 2007. MO PRAMS has been in compliance with all aspects of the CDC PRAMS protocol and has been adequately staffed since the start of the project. MO PRAMS constantly strives to attain a weighted response rate of 65% for the findings to be statistically extrapolated to the general population and wider data dissemination. MO PRAMS played a key role in Missouri's 2010 Title V five year Maternal and Child Health (MCH) Needs Assessment and identification of top ten Missouri MCH priorities. MO PRAMS continues to be a key resource for program planning, evaluation and policy development. Apart from being a key data source to monitor Missouri's progress towards HP 2010 / 2020 objectives and performance measures, MO PRAMS continues to provide valuable data on emerging MCH issues not available through other resources. MO PRAMS findings continue to be disseminated to MCH stakeholders through steering committees, reports, fact sheets, and presentations. The implementation of a new birth certificate in Missouri starting in 2010 did not have any adverse impact on MO PRAMS operations. MO PRAMS is also poised to migrate to the new web based system of data collection beginning in April 2012 and will continue to meet CDC PRAMS requirements and timelines for the project. During the next project period, MO PRAMS will continue to collect high quality data and will further enhance its efforts for data analysis, dissemination, and translation. Special emphasis will be placed on data linkages / analyses between PRAMS, MCH and chronic disease programs with a life course perspective approach.